Locally advanced prostate cancer

Locally advanced prostate cancer is cancer that has started to break out of the prostate, or has spread to the area just outside the prostate.

Watch our animation to find out more about the different stages of prostate cancer:

You may hear locally advanced prostate cancer called stage T3 or T4 prostate cancer. It may have spread to your:

• prostate capsule, which is the outer layer of the prostate
• seminal vesicles, which are two glands that sit behind your prostate and store some of the fluid in semen (the fluid that carries sperm)
• lymph nodes near your prostate, which are part of your immune system
• bladder, which is the part of the body where urine (pee) is stored
• back passage (rectum)
• pelvic wall.

Different doctors may use the term ‘locally advanced prostate cancer’ to mean slightly different things, so ask your doctor or nurse to explain exactly what they mean. They can explain your test results and the treatment options available. Or you could call our Specialist Nurses for more information and support.

Your test results will help your doctor understand how far your cancer has spread and how quickly it might grow. This will help you and your doctor to discuss what treatments might be suitable for you.

Read more about what your test results mean.

Treatments for locally advanced prostate cancer will aim to get rid of the cancer, or to keep it under control, depending on how far the cancer has spread.

The treatment options for locally advanced prostate cancer are:

• external beam radiotherapy with hormone therapy (and sometimes with high dose-rate brachytherapy or permanent seed brachytherapy)
• hormone therapy alone
• surgery (radical prostatectomy), usually with radiotherapy or hormone therapy and sometimes with both. 
• watchful waiting.

A small number of men may be offered high dose-rate brachytherapy on its own, but this is very rare.

Some men may be offered high-intensity focussed ultrasound (HIFU) or cryotherapy but this will usually be as part of a clinical trial.

Depending on how far your cancer has spread, you may have a choice of treatments. If so, your doctor or nurse will talk you through your treatment options and help you choose the right treatment for you. You might not be able to have all of the treatments listed above. Read more about choosing a treatment.

You will have regular check-ups during and after your treatment to check how well it is working. You may hear them called follow-up appointments. You’ll have regular PSA blood tests – ask the people treating you how often you’ll have these. If your PSA level goes down, this usually suggests your treatment is working.

Tell your doctor or nurse about any side effects you’re getting. There are usually ways to manage side effects.

Make sure you have the details of someone to contact if you have any questions or concerns between check-ups. This might be your specialist nurse or key worker. You can also speak to our Specialist Nurses.

Read more about follow up after prostate cancer treatments.

Many men will want to know how successful their treatment is likely to be. This is sometimes called your outlook or prognosis. No one can tell you exactly what will happen, as it will depend on many things, such as the stage of your cancer and how quickly it might grow, your age, and any other health problems.

Many men with locally advanced prostate cancer have treatment that aims to get rid of their cancer. For some men, treatment may be less successful and they may live for many years without their cancer coming back or causing them any problems. For others, treatment may be less successful and the cancer may come back. If this happens, you might need further treatment.

Some men with locally advanced prostate cancer will have treatment that aims to help keep their cancer under control rather than get rid of it completely. For example, if you have hormone therapy on its own, it can help to keep the cancer under control. And there are other treatments available if your hormone therapy stops working so well.

For more information about the outlook for men with prostate cancer, visit Cancer Research UK. The figures they provide are a general guide and they cannot tell you exactly what will happen to you. Speak to your doctor or nurse about your own situation.

You may find it helpful to keep a note of any questions you have to take to your next appointment.

• What is my Gleason score?
• How far has my cancer spread?
• What treatments are suitable for me?
• What do they involve?
• What are the advantages and disadvantages of each treatment, including their possible side effects?
• How effective is my treatment likely to be?
• Can I see the results of treatments you’ve carried out?
• Can I get copies of all my test results and letters about my treatment?
• Is the aim to keep my prostate cancer under control, or to get rid of it completely?
• Are all of the treatments available at my local hospital? If not, how could I have them?
• Can I join any clinical trials?
• How quickly do I need to make a decision?
• After treatment, how often will I have check-ups and what will this involve?
• If I have any questions or get any new symptoms, who should I contact?

What to read next

• Choosing a treatment
• Dealing with my diagnosis
• Living with prostate cancer